| NPI | 1437437449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 08848) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08848) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2023-11-15 |